Multi-Port Surgical Robotic System Architecture

ABSTRACT

A robotic surgery system includes an orienting platform, a support linkage movably supporting the orienting platform, a plurality of surgical instrument manipulators, and a plurality of set-up linkages. Each of the manipulators includes an instrument holder and is operable to rotate the instrument holder around a remote center of manipulation (RC). At least one of the manipulators includes a reorientation mechanism that when actuated moves the attached manipulator through a motion that maintains the associated RC in a fixed position.

CROSS-REFERENCES TO RELATED APPLICATIONS

The present application is a Continuation of U.S. patent applicationSer. No. 15/156,231 filed May 16, 2016 (Allowed); which is aContinuation of U.S. Ser. No. 13/907,009 filed May 31, 2013 (now U.S.Pat. No. 9,358,074); which claims the benefit of U.S. Provisional ApplnNo. 61/654,367 filed Jun. 1, 2012; the full disclosures which areincorporated herein by reference in their entirety for all purposes.

BACKGROUND

Minimally invasive medical techniques are intended to reduce the amountof extraneous tissue that is damaged during diagnostic or surgicalprocedures, thereby reducing patient recovery time, discomfort, anddeleterious side effects. One effect of minimally invasive surgery, forexample, is reduced post-operative hospital recovery times. Because theaverage hospital stay for a standard surgery is typically significantlylonger than the average stay for an analogous minimally invasivesurgery, increased use of minimally invasive techniques could savemillions of dollars in hospital costs each year. While many of thesurgeries performed each year in the United States could potentially beperformed in a minimally invasive manner, only a portion of the currentsurgeries use these advantageous techniques due to limitations inminimally invasive surgical instruments and the additional surgicaltraining involved in mastering them.

Minimally invasive robotic surgical or telesurgical systems have beendeveloped to increase a surgeon's dexterity and avoid some of thelimitations on traditional minimally invasive techniques. Intelesurgery, the surgeon uses some form of remote control (e.g., aservomechanism or the like) to manipulate surgical instrument movements,rather than directly holding and moving the instruments by hand. Intelesurgery systems, the surgeon can be provided with an image of thesurgical site at a surgical workstation. While viewing a two or threedimensional image of the surgical site on a display, the surgeonperforms the surgical procedures on the patient by manipulating mastercontrol devices, which in turn control motion of the servo-mechanicallyoperated instruments.

The servomechanism used for telesurgery will often accept input from twomaster controllers (one for each of the surgeon's hands) and may includetwo or more robotic arms on each of which a surgical instrument ismounted. Operative communication between master controllers andassociated robotic arm and instrument assemblies is typically achievedthrough a control system. The control system typically includes at leastone processor that relays input commands from the master controllers tothe associated robotic arm and instrument assemblies and back from theinstrument and arm assemblies to the associated master controllers inthe case of, for example, force feedback or the like. One example of arobotic surgical system is the DA VINCI® system available from IntuitiveSurgical, Inc. of Sunnyvale, Calif.

A variety of structural arrangements can be used to support the surgicalinstrument at the surgical site during robotic surgery. The drivenlinkage or “slave” is often called a robotic surgical manipulator, andexemplary linkage arrangements for use as a robotic surgical manipulatorduring minimally invasive robotic surgery are described in U.S. Pat.Nos. 7,594,912; 6,758,843; 6,246,200; and 5,800,423; the fulldisclosures of which are incorporated herein by reference. Theselinkages often make use of a parallelogram arrangement to hold aninstrument having a shaft. Such a manipulator structure can constrainmovement of the instrument so that the instrument pivots about a remotecenter of manipulation positioned in space along the length of the rigidshaft. By aligning the remote center of manipulation with the incisionpoint to the internal surgical site (for example, with a trocar orcannula at an abdominal wall during laparoscopic surgery), an endeffector of the surgical instrument can be positioned safely by movingthe proximal end of the shaft using the manipulator linkage withoutimposing potentially dangerous forces against the abdominal wall.Alternative manipulator structures are described, for example, in U.S.Pat. Nos. 7,763,015; 6,702,805; 6,676,669; 5,855,583; 5,808,665;5,445,166; and 5,184,601; the full disclosures of which are incorporatedherein by reference.

A variety of structural arrangements can also be used to support andposition the robotic surgical manipulator and the surgical instrument atthe surgical site during robotic surgery. Supporting linkage mechanisms,sometimes referred to as set-up joints, or set-up joint arms, are oftenused to position and align each manipulator with the respective incisionpoint in a patient's body. The supporting linkage mechanism facilitatesthe alignment of a surgical manipulator with a desired surgical incisionpoint and targeted anatomy. Exemplary supporting linkage mechanisms aredescribed in U.S. Pat. Nos. 6,246,200 and 6,788,018, the fulldisclosures of which are incorporated herein by reference.

While the new telesurgical systems and devices have proven highlyeffective and advantageous, still further improvements are desirable. Ingeneral, improved minimally invasive robotic surgery systems aredesirable. It would be particularly beneficial if these improvedtechnologies enhanced the efficiency and ease of use of robotic surgicalsystems. For example, it would be particularly beneficial to increasemaneuverability, improve space utilization in an operating room, providea faster and easier set-up, inhibit collisions between robotic devicesduring use, and/or reduce the mechanical complexity and size of thesenew surgical systems.

BRIEF SUMMARY

The following presents a simplified summary of some embodiments of theinvention in order to provide a basic understanding of the invention.This summary is not an extensive overview of the invention. It is notintended to identify key/critical elements of the invention or todelineate the scope of the invention. Its sole purpose is to presentsome embodiments of the invention in a simplified form as a prelude tothe more detailed description that is presented later.

Improved robotic surgery systems and modular manipulator supports foruse in robotic surgery systems are disclosed. An improved roboticsurgery system includes an orienting platform that is used to support aplurality of set-up linkages, each of which supports an associatedsurgical instrument manipulator, or manipulators. A support linkage isused to movably support the orienting platform. One or more of thesupport linkages can include a reorientation mechanism operable toreposition the manipulator via a motion that maintains an associatedremote center of manipulation (RC) in a fixed position, thereby allowingthe supported manipulator to be repositioned without the risk ofinducing potentially dangerous forces to a patient at an incisionlocation. And one or more of the support linkages can also include afirst link rotationally coupled to the orienting platform, a second linkslideably mounted to the first link to slide horizontally relative tothe first link, a third link slideably mounted to the second link toslide vertically relative to the second link, and a fourth linkrotationally coupled to the third link to rotate relative to the thirdlink about a vertical axis. The support linkage can include a movablefloor-supported mounting base, and an adjustable linkage coupled to themounting base and movably supporting the orienting platform. Themounting base can also be immovable, for example, by being attacheddirectly to a floor or other fixed structure. The disclosed roboticsurgery systems and modular manipulator supports increasemaneuverability, improve space utilization in an operating room, providea faster and easier set-up, inhibit collisions between robotic devicesduring use, and have reduced mechanical complexity relative to existingsystems and supports having comparable capabilities.

Thus, in one aspect, a robotic surgery system is disclosed that includesan orienting platform, a support linkage movably supporting theorienting platform, a plurality of manipulators, and a plurality ofset-up linkages. Each of the manipulators can include an instrumentholder. Each of the manipulators can be configured to support anassociated surgical instrument mounted to the instrument holder, insertthe associated surgical instrument along an insertion axis into apatient through an associated remote center of manipulation (RC), rotatethe instrument holder around a first manipulator axis that intersectsthe associated RC, and rotate the instrument holder around a secondmanipulator axis that intersects the associated RC. Each of the firstand second manipulator axes is transverse to the insertion axis. Thesecond manipulator axis is transverse to the first manipulator axis.Each of the set-up linkages couples one of the manipulators to theorienting platform and is operable to reposition the associatedmanipulator relative to the orienting platform and fixedly support theassociated manipulator in a selected position relative to the orientingplatform. Each of the set-up linkages includes a proximal link coupledto the orienting platform and a distal link coupled to the associatedmanipulator. At least one of the set-up linkages includes areorientation mechanism that when actuated moves the distal linkrelative to the proximal link through a motion that maintains theassociated RC in a fixed position relative to the proximal link.

In many embodiments, the reorientation mechanism includes a tornadorotational joint and a tornado link. The tornado link has a tornado linkproximal end coupled to the tornado rotational joint and a tornado linkdistal end coupled to the associated manipulator. Actuation of thetornado rotational joint rotates the tornado link around a tornado axisthat intersects the RC and that is not aligned with either of the firstand second manipulator axes. The tornado link is configured to maintainthe associated RC in a fixed position relative to the proximal link forall orientations of the tornado link around the tornado axis.

In many embodiments, at least one of the manipulators is mechanicallyconstrained to maintain a fixed position of the associated RC relativeto the distal link during the rotation of the instrument holder aroundthe first manipulator axis and during the rotation of the instrumentholder around the second manipulator axis. For example, at least one ofthe manipulators can be mechanically configured to move the instrumentholder in response to actuation of a first joint of the manipulatorthrough a first motion that is mechanically limited to rotation aroundthe first manipulator axis and to move the instrument holder in responseto actuation of a second joint of the manipulator through a secondmotion that is mechanically limited to rotation around the secondmanipulator axis.

In many embodiments, the support linkage includes a movablefloor-supported mounting base, a column slideably mounted to themounting base, a boom base member rotationally coupled to the columnthrough a shoulder joint; and an extendable boom member slideablycoupled with the boom base member through a boom joint. The column isselectively positionable relative to the mounting base along a firstsupport axis that is vertically oriented. The shoulder joint is operableto selectively orient the boom base member relative to the column arounda second support axis that is vertically oriented. The boom joint isoperable to selectively position the extendable boom member relative tothe boom base member along a third support axis that is horizontallyoriented. The orienting platform is rotationally coupled to theextendable boom member.

In another aspect, a robotic surgery system is disclosed that includesan orienting platform, a support linkage movably supporting theorienting platform, a plurality of manipulators, and a plurality ofset-up linkages. Each of the manipulators movably supports an associatedsurgical instrument insertable into a patient. Each of the set-uplinkages couples one of the manipulators to the orienting platform andis operable to reposition the associated linkage relative to theorienting platform and fixedly support the associated manipulatorrelative to the orienting platform. At least one of the set-up linkagesincludes a first link, a second link, a third link, and a fourth link.The first link has a first link proximal end rotationally coupled to theorienting platform through a first set-up linkage joint operable toselectively orient the first link relative to the orienting platformaround a first set-up linkage axis. The second link is slideably mountedto the first link through a second set-up linkage joint operable toselectively reposition the second link relative to the first link alonga second set-up linkage axis that is horizontally oriented. The thirdlink is slideably mounted to the second link through a third set-uplinkage joint operable to selectively reposition the third link relativeto the second link along a third set-up linkage axis that is verticallyoriented. The fourth link is rotationally coupled to the third linkthrough a fourth set-up linkage joint operable to selectively orient thefourth link relative to the third link around a fourth set-up linkageaxis that is substantially vertically oriented. The associatedmanipulator is distal to and supported by the fourth link.

In many embodiments, at least one of the manipulators can include aninstrument holder configured to support the associated surgicalinstrument. At least one of the manipulators can be configured to insertthe associated surgical instrument into the patient through anassociated remote center of manipulation (RC), rotate the instrumentholder around a first manipulator axis that intersects the associatedRC, and rotate the instrument holder around a second manipulator axisthat intersects the associated RC. The second manipulator axis istransverse to the first manipulator axis.

In many embodiments, at least one of the set-up linkages includes areorientation mechanism coupled to the fourth link. Actuation of thereorientation mechanism moves the associated manipulator relative to thefourth link through a motion that maintains the associated RC in a fixedposition relative to the fourth link.

In many embodiments, the reorientation mechanism includes a tornadorotational joint and a tornado link. The tornado link has a tornado linkproximal end coupled to the tornado rotational joint and a tornado linkdistal end coupled to the associated manipulator. Actuation of thetornado rotational joint rotates the tornado link around a tornado axisthat intersect the RC and that is not aligned with either of the firstand second manipulator axes. The tornado link is configured to maintainthe associated RC in a fixed position relative to the fourth link forall orientations of the tornado link around the tornado axis.

In another aspect, a modular manipulator support for use in a roboticsurgery system is disclosed. The robotic surgery system includes aplurality of manipulators that include driven links and joints formoving an associated surgical instrument. The modular manipulatorsupport includes a movable floor-supported mounting base, a columnslideably coupled with the mounting base, a boom base memberrotationally coupled to the column through a shoulder joint, anextendable boom member slideably coupled to the boom base member througha boom joint, an orienting platform rotationally coupled to theextendable boom member through a wrist joint, and a plurality of set-uplinkages. The column is selectively positionable relative to themounting base along a first support axis that is vertically oriented.The shoulder joint is operable to selectively orient the boom basemember relative to the column around a second support axis that isvertically oriented. The boom joint is operable to selectively positionthe extendable boom member relative to the boom base member along athird support axis that is horizontally oriented. The wrist joint isoperable to selectively orient the orienting platform relative to theextendable boom member around a fourth support axis that is verticallyoriented. Each of the set-up linkages couples one of the manipulators tothe orienting platform and is operable to selectively position theassociated manipulator relative to the orienting platform and fixedlysupport the associated manipulator relative to the orienting platform.In many embodiments, the angular orientation of the shoulder joint islimited to prevent exceeding a predetermined stability limit of themounting base.

In many embodiments, at least one of the set-up linkages includes afirst link, a second link, a third link, and a fourth link. The firstlink has a first link proximal end rotationally coupled to the orientingplatform through a first set-up linkage joint operable to selectivelyorient the first link relative to the orienting platform around a firstset-up linkage axis. The second link is slideably mounted to the firstlink through a second set-up linkage joint operable to selectivelyreposition the second link relative to the first link along a secondset-up linkage axis that is horizontally oriented. The third link isslideably mounted to the second link through a third set-up linkagejoint operable to selectively reposition the third link relative to thesecond link along a third set-up linkage axis that is verticallyoriented. The fourth link is rotationally coupled to the third linkthrough a fourth set-up linkage joint operable to selectively orient thefourth link relative to the third link around a fourth set-up linkageaxis that is vertically oriented. The associated manipulator is distalto and supported by the fourth link. In many embodiments, the first linkis cantilevered from the first set-up linkage joint in a horizontaldirection.

In many embodiments, at least one of the set-up linkages includes areorientation mechanism coupled to and between the fourth link and theassociated manipulator. Actuation of the reorientation mechanism movesthe associated manipulator relative to the fourth link through a motionthat maintains an associated remote center of manipulation (RC) in afixed position relative to the fourth link.

In many embodiments, the reorientation mechanism includes a tornadorotational joint and a tornado link. The tornado link has a tornado linkproximal end coupled to the tornado rotational joint and a tornado linkdistal end coupled to the associated manipulator. Actuation of thetornado rotational joint rotates the tornado link around a tornado axisthat intersect the RC and that is not aligned with either of the firstand second manipulator axes. The tornado link is configured to maintainthe associated RC in a fixed position relative to the fourth link forall orientations of the tornado link around the tornado axis.

For a fuller understanding of the nature and advantages of the presentinvention, reference should be made to the ensuing detailed descriptionand accompanying drawings. Other aspects, objects and advantages of theinvention will be apparent from the drawings and detailed descriptionthat follows.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a plan view of a minimally invasive robotic surgery systembeing used to perform a surgery, in accordance with many embodiments.

FIG. 2 is a perspective view of a surgeon's control console for arobotic surgery system, in accordance with many embodiments.

FIG. 3 is a perspective view of a robotic surgery system electronicscart, in accordance with many embodiments.

FIG. 4 diagrammatically illustrates a robotic surgery system, inaccordance with many embodiments.

FIG. 5A is a partial view of a patient side cart (surgical robot) of arobotic surgery system, in accordance with many embodiments.

FIG. 5B is a front view of a robotic surgery tool, in accordance withmany embodiments.

FIG. 6 is a perspective schematic representation of a robotic surgerysystem, in accordance with many embodiments.

FIG. 7 is a perspective schematic representation of another roboticsurgery system, in accordance with many embodiments.

FIG. 8 shows a robotic surgery system, in accordance with manyembodiments, in conformance with the schematic representation of FIG. 7.

FIG. 9 illustrates rotational orientation limits of set-up linkagesrelative to an orienting platform of the robotic surgery system of FIG.8.

FIG. 10 shows a center of gravity diagram associated with a rotationallimit of the boom assembly for a robotic surgery system, in accordancewith many embodiments.

FIGS. 11A and 11B are side and front views, respectively, of anexemplary robotic manipulator linkage assembly constructed in accordancewith the principles of the present invention.

FIGS. 12A and 12B are additional side views of the exemplary roboticmanipulator linkage assembly.

FIGS. 13A and 13B are side views of the exemplary robotic manipulatorlinkage assembly illustrating an improved range of motion along a pitchaxis.

FIGS. 14A and 14B are side views of the exemplary robotic manipulatorlinkage assembly illustrating an improved range of motion along a pitchaxis.

FIGS. 15A through 15D are perspective views of the exemplary roboticassembly manipulator linkage illustrating an improved range of motionalong both the pitch and yaw axis.

DETAILED DESCRIPTION

In the following description, various embodiments of the presentinvention will be described. For purposes of explanation, specificconfigurations and details are set forth in order to provide a thoroughunderstanding of the embodiments. However, it will also be apparent toone skilled in the art that the present invention may be practicedwithout the specific details. Furthermore, well-known features may beomitted or simplified in order not to obscure the embodiment beingdescribed.

Minimally Invasive Robotic Surgery

Referring now to the drawings, in which like reference numeralsrepresent like parts throughout the several views, FIG. 1 is a plan viewillustration of a Minimally Invasive Robotic Surgical (MIRS) system 10,typically used for performing a minimally invasive diagnostic orsurgical procedure on a Patient 12 who is lying down on an Operatingtable 14. The system can include a Surgeon's Console 16 for use by aSurgeon 18 during the procedure. One or more Assistants 20 may alsoparticipate in the procedure. The MIRS system 10 can further include aPatient Side Cart 22 (surgical robot) and an Electronics Cart 24. ThePatient Side Cart 22 can manipulate at least one removably coupled toolassembly 26 (hereinafter simply referred to as a “tool”) through aminimally invasive incision in the body of the Patient 12 while theSurgeon 18 views the surgical site through the Console 16. An image ofthe surgical site can be obtained by an endoscope 28, such as astereoscopic endoscope, which can be manipulated by the Patient SideCart 22 to orient the endoscope 28. The Electronics Cart 24 can be usedto process the images of the surgical site for subsequent display to theSurgeon 18 through the Surgeon's Console 16. The number of surgicaltools 26 used at one time will generally depend on the diagnostic orsurgical procedure and the space constraints within the operating roomamong other factors. If it is necessary to change one or more of thetools 26 being used during a procedure, an Assistant 20 may remove thetool 26 from the Patient Side Cart 22, and replace it with another tool26 from a tray 30 in the operating room.

FIG. 2 is a perspective view of the Surgeon's Console 16. The Surgeon'sConsole 16 includes a left eye display 32 and a right eye display 34 forpresenting the Surgeon 18 with a coordinated stereo view of the surgicalsite that enables depth perception. The Console 16 further includes oneor more input control devices 36, which in turn cause the Patient SideCart 22 (shown in FIG. 1) to manipulate one or more tools. The inputcontrol devices 36 can provide the same degrees of freedom as theirassociated tools 26 (shown in FIG. 1) to provide the Surgeon withtelepresence, or the perception that the input control devices 36 areintegral with the tools 26 so that the Surgeon has a strong sense ofdirectly controlling the tools 26. To this end, position, force, andtactile feedback sensors (not shown) may be employed to transmitposition, force, and tactile sensations from the tools 26 back to theSurgeon's hands through the input control devices 36.

The Surgeon's Console 16 is usually located in the same room as thepatient so that the Surgeon may directly monitor the procedure, bephysically present if necessary, and speak to an Assistant directlyrather than over the telephone or other communication medium. However,the Surgeon can be located in a different room, a completely differentbuilding, or other remote location from the Patient allowing for remotesurgical procedures.

FIG. 3 is a perspective view of the Electronics Cart 24. The ElectronicsCart 24 can be coupled with the endoscope 28 and can include a processorto process captured images for subsequent display, such as to a Surgeonon the Surgeon's Console, or on another suitable display located locallyand/or remotely. For example, where a stereoscopic endoscope is used,the Electronics Cart 24 can process the captured images to present theSurgeon with coordinated stereo images of the surgical site. Suchcoordination can include alignment between the opposing images and caninclude adjusting the stereo working distance of the stereoscopicendoscope. As another example, image processing can include the use ofpreviously determined camera calibration parameters to compensate forimaging errors of the image capture device, such as optical aberrations.

FIG. 4 diagrammatically illustrates a robotic surgery system 50 (such asMIRS system 10 of FIG. 1). As discussed above, a Surgeon's Console 52(such as Surgeon's Console 16 in FIG. 1) can be used by a Surgeon tocontrol a Patient Side Cart (Surgical Robot) 54 (such as Patent SideCart 22 in FIG. 1) during a minimally invasive procedure. The PatientSide Cart 54 can use an imaging device, such as a stereoscopicendoscope, to capture images of the procedure site and output thecaptured images to an Electronics Cart 56 (such as the Electronics Cart24 in FIG. 1). As discussed above, the Electronics Cart 56 can processthe captured images in a variety of ways prior to any subsequentdisplay. For example, the Electronics Cart 56 can overlay the capturedimages with a virtual control interface prior to displaying the combinedimages to the Surgeon via the Surgeon's Console 52. The Patient SideCart 54 can output the captured images for processing outside theElectronics Cart 56. For example, the Patient Side Cart 54 can outputthe captured images to a processor 58, which can be used to process thecaptured images. The images can also be processed by a combination theElectronics Cart 56 and the processor 58, which can be coupled togetherto process the captured images jointly, sequentially, and/orcombinations thereof. One or more separate displays 60 can also becoupled with the processor 58 and/or the Electronics Cart 56 for localand/or remote display of images, such as images of the procedure site,or other related images.

FIGS. 5A and 5B show a Patient Side Cart 22 and a surgical tool 62,respectively. The surgical tool 62 is an example of the surgical tools26. The Patient Side Cart 22 shown provides for the manipulation ofthree surgical tools 26 and an imaging device 28, such as a stereoscopicendoscope used for the capture of images of the site of the procedure.Manipulation is provided by robotic mechanisms having a number ofrobotic joints. The imaging device 28 and the surgical tools 26 can bepositioned and manipulated through incisions in the patient so that akinematic remote center is maintained at the incision to minimize thesize of the incision. Images of the surgical site can include images ofthe distal ends of the surgical tools 26 when they are positioned withinthe field-of-view of the imaging device 28.

Robotic Surgery Systems and Modular Manipulator Supports

FIG. 6 is a perspective schematic representation of a robotic surgerysystem 70, in accordance with many embodiments. The surgery system 70includes a mounting base 72, a support linkage 74, an orienting platform76, a plurality of outer set-up linkages 78 (two shown), a plurality ofinner set-up linkages 80 (two shown), and a plurality of surgicalinstrument manipulators 82. Each of the manipulators 82 is operable toselectively articulate a surgical instrument mounted to the manipulator82 and insertable into a patient along an insertion axis. Each of themanipulators 82 is attached to and supported by one of the set-uplinkages 78, 80. Each of the outer set-up linkages 78 is rotationallycoupled to and supported by the orienting platform 76 by a first set-uplinkage joint 84. Each of the inner set-up linkages 80 is fixedlyattached to and supported by the orienting platform 76. The orientingplatform 76 is rotationally coupled to and supported by the supportlinkage 74. And the support linkage 74 is fixedly attached to andsupported by the mounting base 72.

In many embodiments, the mounting base 72 is a movable and floorsupported, thereby enabling selective repositioning of the overallsurgery system 70, for example, within an operating room. The mountingbase 72 can include a steerable wheel assembly and/or any other suitablesupport features that provide for both selective repositioning as wellas selectively preventing movement of the mounting base 72 from aselected position. The mounting base 72 can also have any other suitableconfiguration, for example, a ceiling mount, fixed floor/pedestal mount,a wall mount, or any other suitable mounting surface.

The support linkage 74 is operable to selectively position and/or orientthe orienting platform 76 relative to the mounting base 72. The supportlinkage 74 includes a column base 86, a translatable column member 88, ashoulder joint 90, a boom base member 92, a boom first stage member 94,a boom second stage member 96, and a wrist joint 98. The column base 86is fixedly attached to the mounting base 72. The translatable columnmember 88 is slideably coupled to the column base 86 for translationrelative to column base 86. In many embodiments, the translatable columnmember 88 translates relative to the column base 86 along a verticallyoriented axis. The boom base member 92 is rotationally coupled to thetranslatable column member 88 by the shoulder joint 90. The shoulderjoint 90 is operable to selectively orient the boom base member 92 in ahorizontal plane relative to the translatable column member 88, whichhas a fixed angular orientation relative to the column base 86 and themounting base 72. The boom first stage member 94 is selectivelytranslatable relative to the boom base member 92 in a horizontaldirection, which in many embodiments is aligned with both the boom basemember 92 and the boom first stage member 94. The boom second stagemember 96 is likewise selectively translatable relative to the boomfirst stage member 94 in a horizontal direction, which in manyembodiments is aligned with the boom first stage member 94 and the boomsecond stage member 96. Accordingly, the support linkage 74 is operableto selectively set the distance between the shoulder joint 90 and thedistal end of the boom second stage member 96. The wrist joint 98rotationally couples the distal end of the boom second stage member 96to the orienting platform 76. The wrist joint 98 is operable toselectively set the angular orientation of the orienting platform 76relative to the mounting base 72.

Each of the set-up linkages 78, 80 is operable to selectively positionand/or orient the associated manipulator 82 relative to the orientingplatform 76. Each of the set-up linkages 78, 80 includes a set-uplinkage base link 100, a set-up linkage extension link 102, a set-uplinkage parallelogram linkage portion 104, a set-up linkage verticallink 106, a second set-up linkage joint 108, and a manipulator supportlink 110. In each of the set-up linkage base links 100 of the outerset-up linkages 78 can be selectively oriented relative to the orientingplatform 76 via the operation of the a first set-up linkage joint 84. Inthe embodiment shown, each of the set-up linkage base links 100 of theinner set-up linkages 80 is fixedly attached to the orienting platform76. Each of the inner set-up linkages 80 can also be rotationallyattached to the orienting platform 76 similar to the outer set-uplinkages via an additional first set-up linkage joints 84. Each of theset-up linkage extension links 102 is translatable relative to theassociated set-up linkage base link 100 in a horizontal direction, whichin many embodiments is aligned with the associated set-up linkage baselink and the set-up linkage extension link 102. Each of the set-uplinkage parallelogram linkage portions 104 configured and operable toselectively translate the set-up linkage vertical link 106 in a verticaldirection while keeping the set-up linkage vertical link 106 verticallyoriented. In example embodiments, each of the set-up linkageparallelogram linkage portions 104 includes a first parallelogram joint112, a coupling link 114, and a second parallelogram 116. The firstparallelogram joint 112 rotationally couples the coupling link 114 tothe set-up linkage extension link 102. The second parallelogram joint116 rotationally couples the set-up linkage vertical link 106 to thecoupling link 114. The first parallelogram joint 112 is rotationallytied to the second parallelogram joint 116 such that rotation of thecoupling link 114 relative to the set-up linkage extension link 102 ismatched by a counteracting rotation of the set-up linkage vertical link106 relative to the coupling link 114 so as to maintain the set-uplinkage vertical link 106 vertically oriented while the set-up linkagevertical link 106 is selectively translated vertically. The secondset-up linkage joint 108 is operable to selectively orient themanipulator support link 110 relative to the set-up linkage verticallink 106, thereby selectively orienting the associated attachedmanipulator 82 relative to the set-up linkage vertical link 106.

FIG. 7 is a perspective schematic representation of a robotic surgerysystem 120, in accordance with many embodiments. Because the surgerysystem 120 includes components similar to components of the surgerysystem 70 of FIG. 6, the same reference numbers are used for similarcomponents and the corresponding description of the similar componentsset forth above is applicable to the surgery system 120 and is omittedhere to avoid repetition. The surgery system 120 includes the mountingbase 72, a support linkage 122, an orienting platform 124, a pluralityof set-up linkages 126 (four shown), and a plurality of the surgicalinstrument manipulators 82. Each of the manipulators 82 is operable toselectively articulate a surgical instrument mounted to the manipulator82 and insertable into a patient along an insertion axis. Each of themanipulators 82 is attached to and supported by one of the set-uplinkages 126. Each of the set-up linkages 126 is rotationally coupled toand supported by the orienting platform 124 by the first set-up linkagejoint 84. The orienting platform 124 is rotationally coupled to andsupported by the support linkage 122. And the support linkage 122 isfixedly attached to and supported by the mounting base 72.

The support linkage 122 is operable to selectively position and/ororient the orienting platform 124 relative to the mounting base 72. Thesupport linkage 122 includes the column base 86, the translatable columnmember 88, the shoulder joint 90, the boom base member 92, the boomfirst stage member 94, and the wrist joint 98. The support linkage 122is operable to selectively set the distance between the shoulder joint90 and the distal end of the boom first stage member 94. The wrist joint98 rotationally couples the distal end of the boom first stage member 94to the orienting platform 124. The wrist joint 98 is operable toselectively set the angular orientation of the orienting platform 124relative to the mounting base 72.

Each of the set-up linkages 126 is operable to selectively positionand/or orient the associated manipulator 82 relative to the orientingplatform 124. Each of the set-up linkages 126 includes the set-uplinkage base link 100, the set-up linkage extension link 102, the set-uplinkage vertical link 106, the second set-up linkage joint 108, atornado mechanism support link 128, and a tornado mechanism 130. Each ofthe set-up linkage base links 100 of the set-up linkages 126 can beselectively oriented relative to the orienting platform 124 via theoperation of the associated first set-up linkage joint 84. Each of theset-up linkage vertical links 106 is selectively translatable in avertical direction relative to the associated set-up linkage extensionlink 102. The second set-up linkage joint 108 is operable to selectivelyorient the tornado mechanism support link 128 relative to the set-uplinkage vertical link 106

Each of the tornado mechanisms 130 includes a tornado joint 132, acoupling link 134, and a manipulator support 136. The coupling link 134fixedly couples the manipulator support 136 to the tornado joint 132.The tornado joint 130 is operable to rotate the manipulator support 136relative to the tornado mechanism support link 128 around a tornado axis136. The tornado mechanism 128 is configured to position and orient themanipulator support 134 such that the remote center of manipulation (RC)of the manipulator 82 is intersected by the tornado axis 136.Accordingly, operation of the tornado joint 132 can be used to reorientthe associated manipulator 82 relative to the patient without moving theassociated remote center of manipulation (RC) relative to the patient.

FIG. 8 is a simplified representation of a robotic surgery system 140,in accordance with many embodiments, in conformance with the schematicrepresentation of the robotic surgery system 120 of FIG. 7. Because thesurgery system 140 conforms to the robotic surgery system 120 of FIG. 7,the same reference numbers are used for analogous components and thecorresponding description of the analogous components set forth above isapplicable to the surgery system 140 and is omitted here to avoidrepetition.

The support linkage 122 is configured to selectively position and orientthe orienting platform 124 relative to the mounting base 72 via relativemovement between links of the support linkage 122 along multiple set-upstructure axes. The translatable column member 88 is selectivelyrepositionable relative to the column base 86 along a first set-upstructure (SUS) axis 142, which is vertically oriented in manyembodiments. The shoulder joint 90 is operable to selectively orient theboom base member 92 relative to the translatable column member 88 arounda second SUS axis 144, which is vertically oriented in many embodiments.The boom first stage member 94 is selectively repositionable relative tothe boom base member 92 along a third SUS axis 146, which ishorizontally oriented in many embodiments. And the wrist joint 98 isoperable to selectively orient the orienting platform 124 relative tothe boom first stage member 94 around a fourth SUS axis 148, which isvertically oriented in many embodiments.

Each of the set-up linkages 126 is configured to selectively positionand orient the associated manipulator 82 relative to the orientingplatform 124 via relative movement between links of the set-up linkage126 along multiple set-up joint (SUJ) axes. Each of the first set-uplinkage joint 84 is operable to selectively orient the associated set-uplinkage base link 100 relative to the orienting platform 124 around afirst SUJ axis 150, which in many embodiments is vertically oriented.Each of the set-up linkage extension links 102 can be selectivelyrepositioned relative to the associated set-up linkage base link 10along a second SUJ axis 152, which is horizontally oriented in manyembodiments. Each of the set-up linkage vertical links 106 can beselectively repositioned relative to the associated set-up linkageextension link 102 along a third SUJ axis 154, which is verticallyoriented in many embodiments. Each of the second set-up linkage joints108 is operable to selectively orient the tornado mechanism support link128 relative to the set-up linkage vertical link 106 around the thirdSUJ axis 154. Each of the tornado joints 132 is operable to rotate theassociated manipulator 82 around the associated tornado axis 138.

FIG. 9 illustrates rotational orientation limits of the set-up linkages126 relative to the orienting platform 124, in accordance with manyembodiments. Each of the set-up linkages 126 is shown in a clockwiselimit orientation relative to the orienting platform 124. Acorresponding counter-clockwise limit orientation is represented by amirror image of FIG. 9 relative to a vertically-oriented mirror plane.As illustrated, each of the two inner set-up linkages 126 can beoriented from 5 degrees from a vertical reference 156 in one directionto 75 degrees from the vertical reference 156 in the opposite direction.And as illustrated, each of the two outer set-up linkages can beoriented from 15 degrees to 95 degrees from the vertical reference 156in a corresponding direction.

FIG. 10 shows a center of gravity diagram associated with a rotationallimit of a support linkage for a robotic surgery system 160, inaccordance with many embodiments. With components of the robotic surgerysystem 160 positioned and oriented to shift the center-of-gravity 162 ofthe robotic surgery system 160 to a maximum extent to one side relativeto a support linkage 164 of the surgery system 160, a shoulder joint ofthe support linkage 164 can be configured to limit rotation of thesupport structure 164 around a set-up structure (SUS) shoulder-jointaxis 166 to prevent exceeding a predetermined stability limit of themounting base.

Referring now to FIGS. 11A and 11B, side and front views are illustratedof an exemplary offset remote center robotic manipulator 82 constructedin accordance with the principles of the present invention. As describedin greater detail below, the refined manipulator provides an offsetremote center parallelogram manipulator linkage assembly whichconstrains a position of a surgical instrument 232 coupled to aninstrument holder 234 during minimally invasive robotic surgery. Thesurgical instrument 232 includes an elongate shaft 236 having a distalworking end 238 configured for insertion through an incision in a bodywall into a body cavity of a patient. It will be appreciated that theabove depictions are for illustrative purposes only and do notnecessarily reflect the actual shape, size, or dimensions of the roboticsurgical manipulator 82. This applies to all depictions hereinafter.

Generally, the offset remote center robotic manipulator 82 is configuredto constrain shaft 236 motion relative to a center of rotation 266. Assuch, the shaft 236 is maintained substantially aligned through thecenter of rotation 266 as the shaft 236 is pivotally moved in at leastone degree of freedom. Preferably, the center of rotation 266 is alignedwith the incision point to the internal surgical site, for example, witha trocar or cannula at an abdominal wall during laparoscopic surgery. Assuch, an end effector of the surgical instrument 232 can be positionedsafely by moving the proximal end of the shaft 236 using the offsetremote center robotic manipulator 82 without imposing dangerous forcesagainst the abdominal wall.

Referring back to FIG. 11A, the refined remote center manipulatorgenerally includes an articulate linkage assembly 82 having a mountingbase 240, a parallelogram linkage base 242, and a plurality of links244, 246 and joints 248, 250, 252, 254. The term “joint” is usedinterchangeably with the term “pivot” herein. The mounting base 240 isrotationally coupled to the parallelogram linkage base 242 for rotationabout a first axis 256, also known as the yaw axis, as indicated byarrow 258. The mounting base 240 allows for the surgical manipulator 82to be mounted and supported by set-up arms/joints of a cart mount,ceiling mount, floor/pedestal mount, or other mounting surface. Themounting base 240 in this embodiment is fixed to base support 260 byscrews or bolts 262, wherein the base support 260 is adapted to beattached to the set-up arms/joints. The parallelogram linkage base 242is coupled to the instrument holder 234 by rigid links 244, 246 coupledtogether by rotational pivot joints 248, 250, 252, 254. The links 244,246 and joints 248, 250, 252, 254 define a parallelogram 264 so as toconstrain the elongate shaft 236 of the instrument 232 relative to thecenter of rotation 266 when the instrument 232 is mounted to theinstrument holder 234 and the shaft 236 is moved along a plane of theparallelogram 264.

Significantly, the first axis 256 and the parallelogram 264 intersectthe shaft 236 at the center of rotation 266, wherein the parallelogram264 is angularly offset from the first axis 256. Specifically, a firstside 268 which originates from the first pivot 248 of the parallelogram264 adjacent the parallelogram linkage base 240 and the first axis 256intersect the shaft 236 at the center of rotation 266, wherein the firstside 268 and the first pivot 248 of the parallelogram 264 are angularlyoffset from the first axis 256. The first side 268 and first pivot 248of the parallelogram 264 are offset from the first axis 256 by an anglea of at least 2 degrees, preferably by 10 degrees. Generally, the firstside 268 and first pivot 248 of the parallelogram 264 are offset fromthe first axis 256 by angle a. in a range from about 2 degrees to about45 degrees, preferably in a range from about 2 degrees to about 35degrees.

Referring now to FIGS. 12A and 12B, additional side views of theexemplary robotic manipulator linkage assembly 82 are illustratedshowing the instrument holder 234 in an extended position. The offsetparallelogram 264 arrangement allows for improved rotation of instrument232 and holder 234 over the prior art while the remote center ofrotation 266 remains at the same location. Specifically, as shown inFIGS. 13A, 13B, 14A, 14B, 15C and 15D, the offset articulate linkageassembly 82 provides an improved range of shaft 236 motion that isgreater than ±55 degrees relative to a second axis 267 (which isperpendicular to the page in these illustrations and which passesthrough pivot point 266), preferably greater than ±60 degrees relativeto the second axis 267. Generally, the offset articulate linkageassembly 82 constrains shaft 236 motion about pivot point 266 in a rangefrom ±75 degrees relative to the second axis 267 as indicated by arrow272, wherein the second axis 267 is sometimes referred to as a pitchaxis. The manipulator 82 also provides an improved range of shaft 236motion that is greater than ±90 degrees relative to the first axis 256,preferably greater than ±95 degrees relative to the first axis 256, asindicated by arrow 258 in FIGS. 15A and 15B. Typically, the cantileveredparallelogram linkage base 242 constrains shaft 236 motion about pivotpoint 266 in a range from ±168 degrees relative to the first axis 256.

Additionally, similar to the discussed prior art, the yaw axis 256, thepitch axis (which is perpendicular to the page), and an insertion axis274 all intersect with each other at the remote center 266, which isaligned along a shaft 236 of the instrument 232. Thus, the instrument232 can be pivotally rotated though desired angles as indicated byarrows 258 and 272 while the remote center of rotation 266 remains fixedin space relative to the mounting base 240 (mounting point to set-uparm) of manipulator 82. Hence, the entire manipulator 82 is generallymoved to re-position the remote center 266. It will further beappreciated that the instrument 232 still has further driven degrees offreedom as supported by the offset remote center manipulator 82,including sliding motion of the instrument along the insertion axis 274.

The new and improved offset articulate linkage assembly 82 whichdecouples the first pivot 248 and first side 268 of the parallelogram264 from the yaw axis 256 advantageously enhances the range ofinstrument 232 motion about pivot point 266 relative to the second axis267, as indicated by arrow 272. The manipulator 82 further allows for anenhanced range of motion relative to the first axis 256, as indicated byarrow 258. An improved pivot range of motion along pitch and yaw axes inturn enhances the efficiency and ease of use of such robotic surgicalsystems. For example, the overall complexity of the robotic surgicalsystem may be reduced due to the improved range of motion of the system.Specifically, the number of degrees of freedom in the set-up joints/armsmay be reduced (e.g., less than six degrees of freedom). This allows fora simpler system platform requiring less pre-configuration of the set-upjoints. As such, normal operating room personnel may rapidly arrange andprepare the robotic system for surgery with little or no specializedtraining.

The plurality of links comprise an offset yaw link 242, a loweredvertical link 244, and a main bent link 246. The main link 246 is bentat an angle so as to provide clearance for the vertical link 244 to reston the main bent link 246. This clearance prevents inter-linkagecollisions between the vertical link 244 and the main bent link 246. Forexample, the main link 246 may be bent at an angle of about 22 degreesto allow clearance over a pitch dive 272 as shown in FIGS. 14A, 14B, and15D. In such an embodiment, the main bent link 246 and the vertical link244 as well as the instrument holder 234 are located in the same plane.It will be appreciated however that the main link 246 and the verticallink 244 may alternatively be offset in different planes (i.e., placedside by side) to reduce inter-linkage collisions in lieu of bending mainlink 246. The vertical link 244 pivot 248 is lower relative to the yawaxis 256 so as to provide the offset parallelogram 264 arrangement, asdiscussed above. The yaw link 242 is offset from links 244, 246, as bestseen in FIGS. 15B through 15D. Link 242 and links 244, 246 are not inthe same plane, but are rather offset side by side so as to reduce thepossibility of interlinkage collisions between link 242 and links 244,246.

At least one of the rigid links 242, 244, 246 coupled together byrotational pivot joints 248, 250, 252, 254 are not completely balancedin at least one degree of freedom. As such, a brake system may becoupled to the articulate linkage assembly 82. The brake systemreleasably inhibits articulation of at least one of the joints 248, 250,252, 254. It will be appreciated that the offset remote centermanipulator 82 may comprise a lighter system as the linkage is free ofany counter-balancing weights. As such, the links 242, 244, 246 willpreferably comprise sufficiently rigid and stiff structures so as tosupport any vibration issues associated with the lighter manipulator 82.It will further be appreciated that the offset remote center manipulator82 may optionally be balanced by the use of weights, tension springs,gas springs, torsion springs, compression springs, air or hydrauliccylinders, torque motors, or combinations thereof.

Referring back to FIGS. 12B, 13B, and 14B, the offset remote centermanipulator 82 may preferably comprise six pulleys 276, 278 a, 278 b,280, 282 a, 282 b and four flexible elements 284 a, 284 b, 286 a, 286 bcoupled to the pulleys 276, 278 a, 278 b, 280, 282 a, 282 b that areconfigured to constrain shaft 236 motion relative to the center ofrotation 266. Links 242 and 246 are kept from rotating relative to eachother by flexible elements 284 a, 284 b running on two pulleys 276, 278a, with one pulley 276 fixed to link 242 and one pulley 278 a fixed tolink 246. Links 244 and 234 are likewise kept from rotating relative toeach other by a flexible elements 286 a, 286 b running on the remainingfour pulleys 278 b, 280, 282 a, 282 b, with one pulley 278 b fixed tolink 244, one pulley 280 fixed to link 234, and idler pulleys 282 a, 282b to get the flexible elements 286 a, 286 b around the main bent link246. Hence, links 242 and 246 can translate but not rotate relative toeach other to maintain the parallelogram shape 264. Likewise, links 244and 234 can translate but not rotate relative to each other to maintainthe parallelogram shape 264. It will be appreciated that the term pulley276, 278 a, 278 b, 280, 282 a, 282 b can include wheels, gears,sprockets, and the like.

The flexible element 284 a, 284 b, 286 a, 286 b may include belts,chains, or cables connected around the pulleys 276, 278 a, 278 b, 280,282 a, 282 b. Preferably, the flexible elements comprise multi-layermetal belts, such as stainless steel belts having a breaking strength ofapproximately 800 lbs and being about a quarter inch wide. The belts arepreferably multilayered utilizing at least 3 plies, preferably 5 pliesto be strong enough to carry an adequate tension load yet sufficientlythin enough to not fatigue when repeatedly bent around the pulleys.Pulleys 276 and 278 a have approximately the same diameter, e.g., 2.2inches. Smaller pulleys 278 b and 280 have approximately the samediameter, e.g., 1.8 inches. There are two idler pulleys 282 a, 282 b atthe bend of the main link 246 to facilitate running of belts 286 a, 286b in opposite directions so as to allow for attachment of the belts endsto be more robust. Utilization of non-continuous offset belts 284 a, 284b and 286 a, 286 b provides for stress reduction, particularly at theattachment points, thus minimizing failures. Further, non-continuousbelts allow for convenient tension and position adjustments. It willfurther be appreciated that belts 284 a, 284 b as well as belts 286 a,286 b may optionally comprise continuous single belts. Additionally, themetal belts may be lightly coupled to flat flex cables that carryelectrical signals along the manipulator arm.

The offset articulate linkage assembly 82 is driven by a series ofmotors. Motors may be located within the plurality of links to drive thepulley and belt mechanisms. Preferably, a majority of the motors arehoused in the lowered vertical link 244. In particular, the motor whichdrives the pitch axis 272 rotating link 244 relative to link 242 throughspur gears and a harmonic drive as well as the motors that runinstrument actuation cables (e.g., wrist drive cables which may bespring tensioned) may be housed in link 244. Placement of the verticallink 244, the main bent link 246, and the instrument holder 234 in thesame plane is advantageous as the motors that run the actuation cablesare housed in link 244. Further, having the vertical link 244, the mainbent link 246, and the instrument holder 234 in the same plane allowsfor space minimization at the distal end of the manipulator 82, which isof significant importance when performing minimally invasive roboticsurgery in a confined operating environment. The motor driving the yawaxis 258 may be housed in mounting base 240.

Other variations are within the spirit of the present invention. Thus,while the invention is susceptible to various modifications andalternative constructions, certain illustrated embodiments thereof areshown in the drawings and have been described above in detail. It shouldbe understood, however, that there is no intention to limit theinvention to the specific form or forms disclosed, but on the contrary,the intention is to cover all modifications, alternative constructions,and equivalents falling within the spirit and scope of the invention, asdefined in the appended claims.

The use of the terms “a” and “an” and “the” and similar referents in thecontext of describing the invention (especially in the context of thefollowing claims) are to be construed to cover both the singular and theplural, unless otherwise indicated herein or clearly contradicted bycontext. The terms “comprising,” “having,” “including,” and “containing”are to be construed as open-ended terms (i.e., meaning “including, butnot limited to,”) unless otherwise noted. The term “connected” is to beconstrued as partly or wholly contained within, attached to, or joinedtogether, even if there is something intervening. Recitation of rangesof values herein are merely intended to serve as a shorthand method ofreferring individually to each separate value falling within the range,unless otherwise indicated herein, and each separate value isincorporated into the specification as if it were individually recitedherein. All methods described herein can be performed in any suitableorder unless otherwise indicated herein or otherwise clearlycontradicted by context. The use of any and all examples, or exemplarylanguage (e.g., “such as”) provided herein, is intended merely to betterilluminate embodiments of the invention and does not pose a limitationon the scope of the invention unless otherwise claimed. No language inthe specification should be construed as indicating any non-claimedelement as essential to the practice of the invention.

Preferred embodiments of this invention are described herein, includingthe best mode known to the inventors for carrying out the invention.Variations of those preferred embodiments may become apparent to thoseof ordinary skill in the art upon reading the foregoing description. Theinventors expect skilled artisans to employ such variations asappropriate, and the inventors intend for the invention to be practicedotherwise than as specifically described herein. Accordingly, thisinvention includes all modifications and equivalents of the subjectmatter recited in the claims appended hereto as permitted by applicablelaw. Moreover, any combination of the above-described elements in allpossible variations thereof is encompassed by the invention unlessotherwise indicated herein or otherwise clearly contradicted by context.

All references, including publications, patent applications, andpatents, cited herein are hereby incorporated by reference to the sameextent as if each reference were individually and specifically indicatedto be incorporated by reference and were set forth in its entiretyherein.

1. A surgery system comprising: a support linkage; an orienting platformmovably supported by the support linkage; a manipulator comprising aninstrument holder configured to support a surgical instrument, wherein aremote center of motion is defined for the manipulator, the manipulatoris configured to insert the surgical instrument along an insertion axisthat intersects the remote center of motion, the manipulator isconfigured to rotate the instrument holder around a manipulator firstaxis that intersects the remote center of motion and is transverse tothe insertion axis, and the manipulator is configured to rotate theinstrument holder around a manipulator second axis that intersects theremote center of motion and is transverse to the insertion axis and themanipulator first axis; and a set-up linkage coupled between theorienting platform and the manipulator, wherein the set-up linkagecomprises an extension link coupled to the orienting platform, avertical link coupled to the manipulator, and a set-up linkageparallelogram portion coupling the vertical link to the extension link,the set-up linkage portion being configured and operable to selectivelytranslate the vertical link vertically while keeping the vertical linkvertically oriented.
 2. The surgery system of claim 1, wherein theset-up linkage comprises: a manipulator support link coupled to themanipulator; and a distal set-up linkage joint coupling the manipulatorsupport link to the vertical link, the distal set-up linkage joint beingconfigured and operable to selectively reorient the manipulator supportlink relative to the vertical link.
 3. The surgery system of claim 2,wherein the distal set-up linkage joint is configured and operable toselectively reorient the manipulator support link relative to thevertical link around a distal set-up linkage joint axis that isvertically oriented.
 4. The surgery system of claim 1, wherein: theset-up linkage comprises a base link coupled to the orienting platformand coupling the extension link to the orienting platform; and theset-up linkage is configured and operable to selectively translate theextension link horizontally relative to the base link.
 5. The surgerysystem of claim 4, wherein the set-up linkage comprises a proximalset-up linkage joint coupling the base link to the orienting platform,the proximal set-up linkage joint being configured and operable toselectively reorient the base link relative to the orienting platform.6. The surgery system of claim 5, wherein the proximal set-up linkagejoint is configured and operable to selectively reorient the base linkrelative to the orienting platform around a proximal set-up linkagejoint axis that is vertically oriented.
 7. The surgery system of claim1, further comprising: a second manipulator comprising a secondinstrument holder configured to support a second surgical instrument,wherein a second remote center of motion is defined for the secondmanipulator, the second manipulator is configured to insert the secondsurgical instrument along a second insertion axis that intersects thesecond remote center of motion, the second manipulator is configured torotate the second instrument holder around a second manipulator firstaxis that intersects the second remote center of motion and istransverse to the second insertion axis, and the second manipulator isconfigured to rotate the second instrument holder around a secondmanipulator second axis that intersects the second remote center ofmotion and is transverse to the second insertion axis and the secondmanipulator first axis; and a second set-up linkage coupled between theorienting platform and the second manipulator, wherein the second set-uplinkage comprises a second extension link coupled to the orientingplatform, a second vertical link coupled to the second manipulator, anda second set-up linkage parallelogram portion coupling the secondvertical link to the second extension link, the second set-up linkageportion being configured and operable to selectively translate thesecond vertical link vertically while keeping the second vertical linkvertically oriented.
 8. The surgery system of claim 7, wherein thesecond set-up linkage comprises: a second manipulator support linkcoupled to the second manipulator; and a second distal set-up linkagejoint coupling the second manipulator support link to the secondvertical link, the second distal set-up linkage joint being configuredand operable to selectively reorient the second manipulator support linkrelative to the second vertical link.
 9. The surgery system of claim 7,wherein: the second set-up linkage comprises a second base link coupledto the orienting platform and coupling the second extension link to theorienting platform; and the second set-up linkage is configured andoperable to selectively translate the second extension link horizontallyrelative to the second base link.
 10. The surgery system of claim 9,wherein the second set-up linkage comprises a second proximal set-uplinkage joint coupling the second base link to the orienting platform,the second proximal set-up linkage joint being configured and operableto selectively reorient the second base link relative to the orientingplatform.